Abstract

When the vertigo of Menieretextquoterights disease becomes refractory to medical management, a variety of surgical options are available. If intratympanic gentamicin has failed or is not recommended and serviceable hearing is present, sectioning the vestibular nerve is an excellent option in terms of vertigo control, hearing preservation, and postoperative quality of life. Transection of the vestibular nerve has gone through a metamorphosis since attempted by Krause over a century ago. The microsurgical posterior fossa vestibular neurectomy has undergone an evolution, resulting in the combined RRVN. This is essentially a retrosigmoid approach with exposure of the lateral venous sinus to allow forward retraction of the sinus and better exposure. This technique has the advantages of minimization of required mastoid and suboccipital bone work, elimination of the need for cerebellar retraction, improved exposure, ability to achieve watertight dural closure to minimize incidence of CSF leakage, low incidence of postoperative headache, and low overall complication rate. If a cleavage plain cannot be readily identified, then the superior half of the eighth nerve is sectioned near the brainstem. The results are essentially the same whether the vestibular nerve is cut in the IAC or the posterior fossa. Vertigo has been completely controlled in 85% and hearing has been preserved at the preoperative level in 80% of patients. Combined RRVN is a direct and safe technique, with high success in properly selected patients.